Occupational Health Surveillance Perspectives on e-SUS Linha da Vida Program

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In the context of def ining priorities and comprehensive care strategies, workers' health information should be based on each territorial circumscription or specific regionalization.Thus, in November 2022, the Ministry of Health launched the e-SUS Linha da Vida Program with the objective of integrating national coverage notification systems, in order to gather health surveillance data on the entire Brazilian population. 5This program offers a promising perspective in improving the quality of data regarding work-related diseases and injuries, considering that the program aims to integrate available information on vital statistics and morbidities, and therefore, addressing the existing fragmentation of information on workers' health among different Health Information Systems (HIS).
The objective of this article was to discuss the potential for improving occupational health surveillance actions, based on the consolidation of the e-SUS Linha da Vida Program.

OPINION ARTICLE
Occupational Health and the e-SUS Linha da Vida Program injuries, diseases and deaths.These systems also assist in recording exposures and health risk factors present in work environment and processes. 6 Brazil, the main HIS for VISAT encompass the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação -SINAN), the Mortality Information System (Sistema de Informações sobre Mortalidade -SIM) and the Hospital Information System of the Brazilian National Health System (Sistema de Informações Hospitalares do Sistema Único de Saúde -SIH/SUS) (Box 1).6 Although the country has different data sources of interest to workers' health, the lack of interoperability among them and the difficulty in accessing the identified data pose challenges to epidemiological monitoring and scientific research.
Given the lack of interoperability, an alternative approach that has gained prominence within VISAT, is the use of database linkage techniques, universally known as "record linkage". 7However, the availability of probabilistic linkage methods and the accuracy of these techniques cannot avoid the direct influence of the quality of the user data, especially if the data has been input incorrectly. 7n addition, it is important to consider the absence of a unique and consistent identifier between the systems, such as the Taxpayer Identification number (Cadastro de Pessoa Física -CPF) or the National Health Card (Cartão Nacional de Saúde -CNS) number.
In this context, the e-SUS Linha da Vida Program stem from the necessity of having a single and reliable source of data.A need that was especially recognized during the COVID-19 pandemic. 5 is worth mentioning the substantial underreporting of work-related diseases and injuries, which poses a challenge to the effectiveness of VISAT's actions, 8 despite the recent increase in the number of reported cases on SINAN. 9Underreporting hinders a more comprehensive understanding of the underlying factors behind accidents and illnesses, making it difficult to implement targeted interventions.
Some limitations of the current HIS that are relevant to VISAT, include the absence of return flow -data sharing between the municipalities of notification and the case's residence -for the notifications of work-related diseases and injuries, on SINAN. 10Furthermore, the coding lists for the "occupation" field, based on the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações -CBO), and the "economic activity" field, based on the National Classification of Economic Activities (Classificação Nacional de Atividades Econômicas -CNAE), show that the HIS have not been updated.These lists do not include new occupation codes, which are created anually and introduced into the systems of the Ministry of the Labor and Employment of Brazil, 11 nor do they include the codes from CNAE in its version 2.0, implemented in 2007. 12SINAN, specifically, uses CNAE version 1.0, 2002. 13other limitation of the HIS lies in the absence of fields that enable the identification of the relationship between illness and work in some notification forms, such as the individual tuberculosis notification/investiogation form. 14On the other hand, in the SIM, the "occupational accident" field in the Death Certificate (DC) only allows registration for deaths due to external causes, specifically accidents (ICD-10: V01 to X59).This prevents work-related connection for deaths resulting from noncommunicable diseases, communicable diseases, homicides, suicides and other forms of violence. 15e obstacles encountered in different HIS compromise the epidemiological investigation process of work-related cases and deaths, with a negative impact on data quality and, consequently, on worker's health information.In light of the recent transformations in the world of work, boosted by the COVID-19 pandemic, epidemiological surveillance models for occupational health and HIS need to be reconsidered to equally address the social determinants of health, especially those related to work process and environment.

VISAT PERSPECTIVES ON THE e-SUS LINHA DA VIDA PROGRAM
The e-SUS Linha da Vida Program aims to compile individual information -currently present in different HIS 16 -from birth to death, gathering information on health conditions, diseases, hospitalizations, etc., within the system.This Program represents a significant change in the HIS approach as it focuses on the individual, rather than the disease or health condition.It is estimated that the e-SUS Linha da Vida Program will be implemented in the Brazilian health surveillance services by 2025. 5e person-centered focus provides a more comprehensive perspective on the relationship between health and work, enabling an understanding of different cycles and potential impacts of

OPINION ARTICLE
Occupational Health and the e-SUS Linha da Vida Program work on an individual's health over time.This approach is crucial because it expands the detection of work-related diseases, given that many of them have a long latency period, making it challenging to immediately identify the causal relationship with current or previous work. 17By enabling the recording of occupational history and economic activity, the Program makes it possible to know the potential occupational risks to which an individual has been exposed throughout his or her life.This quality will enable a more accurate -and effective -identification of the workers' health status, the prioritization of the most affected groups and the planning of more appropriate intervention actions.
The Program's main potential is also due to data standardization and integration of different information sources.Based on a minimum data set (MDS) and the adoption of standardized terminologies, the e-SUS Linha da Vida Program aims to establish a common language and a consistent data structure. 7Data standardization will solve, for example, the problem of noninteroperability between the HIS, which has been addressed through record linkage techniques to date. 6Furthermore, standardization will enable the use of MDS in integrating with databases that do not belong to the health sector, such as the Occupational Accident Information System (Sistema de Informação de Acidentes de Trabalho -SISCAT), of the Ministry of Social Security, and the Annual Social Information Report (Relação Anual de Informações Sociais -RAIS), of the Ministry of Labor and Employment, databases that provide information on Brazilian workers.

FINAL CONSIDERATIONS
Fast and safe access to critical information is essential for health decision-making and the timely implementation of prevention measures in the workplace, in addition to contributing to the identification of emerging problems related to workers' health.
The e-SUS Linha da Vida Program creates opportunities for strengthening VISAT by enabling proper monitoring and greater understanding of the effects of work on an individual's life.This, in turn, can lead to the improvement of the analysis of the occupational health situation and the development of surveillance policies and actions, reinforcing the National Network of Comprehensive Occupational Health Care (Rede Nacional de Atenção Integral à Saúde do Trabalhador -RENAST); and, consequently, expanding measures for the prevention of work-related diseases and injuries, offering the possibility of implementing a systemic and reliable monitoring of workers' health in Brazil.

Brazilian National Health System (Sistema de Informações Hospitalares do Sistema Único de Saúde -SIH/SUS) of interest to occupational health surveillance
International Statistical Classification of Diseases and Related Health Problems -10 th Revision.Sources: SINAN Notification/Investigation forms, Death Certificate (DC) and Hospital Admission Authorization via the Brazilian National Health System (Autorização de Internação Hospitalar pelo Sistema Único de Saúde -AIH-SUS).